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DSH240004BR HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER (Active)
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Main Details
Name
HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER
Subdivision Name
HENNEPIN HEALTHCARE SYSTEM INC - Comprehensive Weight Mgmt Ctr
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240004BR
Medicare Provider Number
240004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/13/2023
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Hennepin Healthcare System
Wendy Stulac-Motzel, Chief Operating Officer
(612) 873-6123
Primary Contact
Hennepin Healthcare Systems, Inc. - HCMC
Heather Anderson, Pharmacy Revenue Manager
(612) 873-3225
Addresses
Street Address
701 PARK AVE
MINNEAPOLIS, MN 55415-1623
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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